Tuesday, July 27, 2010

Here's a question: How do you introduce the concept of death to a child with an anxiety disorder without creating intense anxiety for him?

And here's another: How do you introduce the concept if the child has autism, which means that 1) he has trouble understanding the abstract, and instead focuses on the very real and the very concrete and 2) he is prone to perseverating on issues and can zero in on a single topic for hours, days, or weeks at a time?

In other words, how do you introduce the concept of death to this child without planting the seeds of worry that will swiftly grow into "I will die" and "you will die" and "it could happen any time"?

How do you introduce the concept and then expect to ever have a conversation with this child about anything else for the rest of his life?

Weighty issues for a mid-summer night, I know, but it's a topic that has been on my mind a lot, because in recent days, some new words have crept into Bud's vocabulary: Guns. Kill. Die.

They are words he uses with a worried tone.

"Mom," he said as we were driving to summer school yesterday, "if people are killing me with guns, I'll hide behind a rock."

I nearly drove off the road.

"Bud," I said, "that would never, never happen. Where did you hear about people with guns?" I couldn't imagine the source. As far as I knew, Bud had no frame of reference for killing and he had no idea what a gun was. The only television shows that he watches are preschool programs, none of which have such dark themes. He doesn't even see commercials.

Which means that he has been processing those images on his own for at least a month.

I reminded Bud that things that happen in movies aren't real, but since we were nearly at school, I didn't pursue the conversation any further. Instead, I decided to think about how to approach the issue more thoughtfully.

Tonight at bedtime, before I'd had a chance to develop a thoughtful plan, Bud raised the issue again.

"Mom, those are guns?"

"What are guns, Bud?"

"Guns are machines."

"No, I know that. What guns are you asking about?"

"At the pharmacy? Those are toy guns?"

"I guess they do have toy guns at the pharmacy. I don't really think guns are good toys."

"They're bad?"

"Well, I don't like them."

"Guns are bad, Mom?"

"Well, guns aren't toys, Bud."

"Guns kill elephants?"

What???

"Did they shoot elephants in Chitty Chitty Bang Bang?"

"NO! They shoot people in Chitty Chitty Bang Bang."

"Who shoots elephants?"

"The hunters do!"

"What hunters?"

"In the BOOK! In summer school! That I read with Ms. Barr."

"Oh. What happens when they shoot the elephants?"

"They kill them."

"What does kill mean?"

"It means they die."

"Oh. And what does die mean?"

Bud thought about it. "Well..." he said, "it means they get sick."

"And then what happens?"

"They go to the doctor."

"And what happens after they go to the doctor?"

"They take their temperature."

Ah. His constructed understanding of killing and death - already disconcerting and alarming to him - is missing a critical element.

Which is why I find myself, in the middle of this lovely summer, with dark and weighty issues on my mind.

Where do I go from here?

How do I help my son understand the cycle of life and death without inciting panic?

And is preserving his naivete and allowing him to stay happily unaware truly the more compassionate path? Is it wise to take the risk that Bud will be introduced to the very idea of death when someone he loves is gone from his life?

I tried to introduce it to him several years ago when his goldfish died, but the losses barely registered with him. The fish were here, the fish were gone. The impact was minimal. But Bud is in a very different developmental place now, and the stakes feel a whole lot higher. If I don't process it with him, he will surely continue to process it on his own.

So, really: how do you do it?

How do you help a child with autism and anxiety understand death without killing his joyful and optimistic approach to life?

Saturday, July 03, 2010

You may know that Bud has been taking melatonin for years to help him sleep through the night. As he's grown, we've had to increase the dose to maintain its effectiveness, and for the past year or so he's been taking 9 mg a night - a dose that would leave most adults groggy for days, but which has been just enough to help Bud get a solid night's sleep.

This spring, however, with the anxiety of the end of school, the unknowns of summer, and a new school year looming large on his horizon, Bud started to have trouble sleeping again, and his 9 mg dose was rendered ineffective. The doctor he sees for medication management authorized us to go up to 12 mg a night, but before we got started with that, Bud had an appointment with his pediatrician, who asked me about the melatonin I was giving Bud and, specifically, about where I'd been buying it. I told her I usually picked it up at Target or the local pharmacy, and she gave me a valuable tip.

She said that melatonin, like most natural supplements, is not regulated, so a 3 mg tablet may not actually contain 3 mg of pure melatonin. She suggested that I go online and order "pharmaceutical grade melatonin" and try that before I increased Bud's dose. It worked beautifully. Bud's holding steady at 9 mg a night and has been sleeping soundly - even during the past week, when we were away from home on vacation.

I wish I'd known about this years ago, so I'm passing it along, in case any of you are having hit-or-miss experience with over-the-counter melatonin.